Ultrasound in pregnancy
Dear Patient, In our clinic we perform routine obstetric ultrasound examinations, dedicated exams (with focus in specific systems) and counseling in cases of fetal anomalies. Dr, Krajden Haratz is specialist in Fetal Neurosonography (Fetal Brain Scans) and study of the fetal spine as well as cases of suspected intrauterine infection.
All our exams are recorded in video and photos and you will take home 2 DVD’s together with a detailed exam report.
Performed by transvaginal route between 6 and 10 gestational weeks. The aims of this exam are diagnosis of placement of pregnancy (inside or outside the uterus), number of fetuses and the presence of fetal heart beats.
This exam also allows the identification of other relevant problems that may be present during the gestation as uterine nodules (myomas), ovarian cysts and others.
Nuchal translucency and Risk calculation for Down syndrome with early morphology assessment
This exam must be performed between 11 and 13+6 gestational weeks for the calculation of risk for Down Syndrome in the fetus. In most cases it is performed by the transabdominal route, and the transvaginal used only when needed.
In most services, at this gestational age, only the nuchal translucency (NT) measurement is performed along with fetal measurement and presence of heart beats, with no assessment of fetal anatomy.
Dr. Krajden Haratz is certified by the Fetal Medicine Foundation in London (Prof. Kypros Nicolaides) for the performance of the First Trimester Scan, offering her patients a very detailed and extended first trimester evaluation together with the Down’s Syndrome risk assessment. This approach adds other genetic anomalies markers and a dedicated anatomic fetal survey for early diagnosis of fetal anomalies and reaches best results when performed during the 12-13th weeks.
obs1.: The accepted guidelines recommend for patients that perform the Nuchal Translucency test to take also the Biochemistry screening of the First trimester in order to rise the detection rate for Down Syndrome.
obs2: It is important to know that the only way to diagnose for sure whether the fetus has a chromosomic anomaly is performing an invasive test (amniocentesis or chorionic villi sampling – (דיקור מי שפיר או סיסי שיליה). Those tests, however have a low rate of pregnancy loss and are not medically indicated in most cases when screening tests are normal. In Israel these exams are generally indicated and are subsidized by the Ministry of Health when patients are 35 years or older, when the risk for DS is higher then 1:300 or when abnormal findings are found in ultrasound scans. All patients must be submitted to a genetic counseling before performing these invasive tests (יעוץ גנטי).
Second Trimester Scan – Anatomical Survey
This exam is considered one of upmost importance in the fetal development assessment process during pregnancy. It adds individualizing your prenatal assistance, planning your delivery and provides essential information to your ObGyn about the evolution of your pregnancy.
In Israel the fetal anatomic survey is performed routinely twice during pregnancy, between 14-16 weeks ((סקירה מוקדמת and again between 20-24 weeks (סקירה מאוחרת). The first exam is performed by the combination of transvaginal and transabdominal assessment for best resolution of fetal imaging. The second is performed by transabdominal route and the transvaginal used when needed for technical aspects and for uterine cervix length measurement (for prediction of preterm labor risk).
The second trimester scan must be performed by and experienced and certified physician, with knowledge on pregnancy physiology, fetal anomalies and obstetric problems. During the exam the different anatomic organs and systems are minuciously assessed, as well as fetal growth, the placenta, the amount of amniotic fluid and the cervical length. In her practice, Dr Krajden Haratz uses high technology equipment and adds 3D and 4D technology in fetal assessment (not only the baby face) to rise the diagnostic rate of the scans.
The advantages of the first scan (weeks 14-16) is the possibility of early diagnosis of fetal anomalies and referral for further investigation including invasive diagnostic procedures. It’s important to notice, however that this exam does not substitute the Nuchal Translucency + Biochemistry for Down Syndrome screening. The last has the higher diagnostic rate (about 85-90%), when the second trimester scans reach only 70% for this specific condition.
Other parameters may be added to the second trimester scans whenever indicated, including Doppler studies for the assessment of the uterine and fetal vessels (prediction of hypertension in pregnancy, fetal growth restriction, fetal anemia, etc).
Obs: during the first scan (14-16 weeks) it is possible to diagnose the fetal sex in almost 100% of the cases).
This exam is directed for the study of the fetal central nervous system, including the brain and spine. It may be performed in all pregnancy stages depending on the indication, mostly during the second or third trimesters. The fetal assessment is performed by both transabdominal and transvaginal routes, depending on fetal position for best imaging.
Dr. Krajden Haratz is specialist in Fetal Brain Assessment and is member of the Fetal Neurology Clinic at Wolfson Medical Center, pioneer in the field in Israel. Her advanced research studies are being focused on this area, including her Master Degree Thesis (Federal University of Sao Paulo) and many papers published in peer-reviewed journals. Dr Krajden Haratz was fellow of Prof Gustavo Malinger in Prenatal Diagnosis and Fetal Neurology and is Faculty Member of the Fetal Neurology Masterclass which trains physicians from all over the world in this field of expertise, as well as other academic activities, national and international.
The exam is performed in high technology ultrasound machines equipped with high resolution 2D and 3D probes. The most common indications for the exam are dilation of the lateral ventricles, fetal head measurements out of the reference ranges (smaller or bigger than expected), suspected fetal infection by viruses or parasites (CMV, toxoplasmosis, herpes…), use of medication during pregnancy, family history of mental retardation, fetal malformations, brain cysts, severe fetal growth restriction, twin pregnancies.
In the presence of abnormal findings, the patient will be addressed for multidisciplinary assessment and counseling including geneticist, pediatric neurologist and neurosurgeon whenever needed. MRI studies of the fetal brain may also be indicated as a complimentary tool in specific cases, according to medical judgment.
Ultrasound dedicated to specific systems or conditions
In specific situations there is need for additional scans focused on one or more fetal systems, as when abnormal findings are present in previous scans, family history of genetic conditions or malformations, high risk for fetal anomalies (use of medication, maternal clinical illnesses...)
This exam is performed under medical indication (the primary care physician, the sonographer or the geneticist) and may be indicated in any time of the pregnancy.
Common examples are: exams dedicated to high or low amount of amniotic fluid, central nervous system, the urinary system. As for second trimester scans, this exam must be performed by experienced professionals using advanced us equipment. Many times the scan is part of a multidisciplinary approach including physicians of other areas of expertise in order to offer the patient the best counseling.
This exam assesses the fetal development later in gestation, between 30-32 weeks. Its objective is to detect fetal malformations (congenital or acquired) that may have appeared after the second scan and could not have been detected in earlier examinations These anomalies comprehend 10-15% of all the anomalies that may be diagnosed using ultrasound in pregnancy and the digestive, urinary and central nervous systems are the most frequently affected.
These anomalies of late appearance may occur due to a problem specific in the system development or due to an external insult (trauma, infection) during pregnancy. A significant number of brain malformations, unfortunately, may be diagnosed only later in pregnancy because oft he mechanism of fetal brain development that is a little different from other organs and changes its shape dramatically during the third trimester with the development of the external layers of the brain (cortex).
In Israel this exam is not part of the so called סל הבריאות and not yet of the routine indications presented by the ObGyn society, but it may be performed in private clinics when the health care practitioner thinks suitable. Its important to remember that the third trimester scan is only complimentary and does not substitute the second trimester scans, which are the standard of care during pregnancy. Due to fetal position and technical issues not always the whole fetal anatomy may be covered by the later exam.
Fetal growth and Obstetric Dopplerfluxometry
Assessment of fetal growth and blood circulation for estimation of placental function, fetal severe anemia, heart function. The Doppler study may be performed to assess the flow in different vessels according to the indication: as uterine arteries, umbilical arteries, middle cerebral artery, ductus venosus, among others.
- Reduced fetal movements.
- Reduced / Enlarged amount of amniotic fluid (olygo/polyhydramnios)
- Fetal growth restriction
- Maternal chronic hypertension
- Maternal Pre-eclampsia (gestational hypertension)
- Maternal hypercoagulation states (thrombophilia)
- Screening for risk of preeclampsia and growth restriction
- Assessment of fetal wellbeing in third trimester
- Screening for fetal anemia
- Pregestational Diabetes (type 1 or 2)
- Multiple gestations
- Placental anomalies (placenta previa, suspected invasive placenta)
- Single umbilical artery
Ultrasound in multiple gestations
Multiple gestations (twins, triplets) require special work-up and follow-up along the pregnancy.
Ultrasonography is one of the essential tools for the assessment of fetal wellbeing and development in multiple gestations since the early first trimester with the diagnosis of the number of fetuses, the number of gestational sacs / placentas and the number of amniotic cavities (water sacs). This data is called chorionicity and it is crucial for the planning of the whole prenatal care in multiple pregnancies.
The pregnancies in which fetuses share the same placenta (called monochorionic) there’s a need for special high risk prenatal care and ultrasound follow-up in order to detect possible complications specific of these cases. As the incidence of fetal anomalies is somewhat higher in multiple pregnancies, an experienced sonographer is indicated for your pregnancy follow-up and anatomic scans.
Dr. Karina Krajden Haratz
Ultrasound in Obstetrics and Gynecology and Fetal Medicine
18, Abba Ahimeir Street - Ramat Aviv
For appointments *8564